| Title: |
A randomised controlled trial of matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDITOF-MS) versus conventional microbiological methods for identifying pathogens: Impact on optimal antimicrobial therapy of invasive bacterial and fungal infections in Vietnam |
| Authors: |
Nadjm, B; Dat, VQ; Campbell, JI; Dung, VTV; Torre, A; Tu, NTC; Van, NTT; Trinh, DT; Lan, NPH; Trung, NV; Hang, NTT; Hoi, LT; Baker, S; Wolbers, M; Chau, NVV; Van Kinh, N; Thwaites, GE; Van Doorn, HR; Wertheim, HFL |
| Publisher Information: |
Elsevier |
| Publication Year: |
2019 |
| Collection: |
Oxford University Research Archive (ORA) |
| Description: |
OBJECTIVES: We assessed the impact of MALDITOF-MS on the timeliness of optimal antimicrobial therapy through a parallel-arm randomised controlled trial in two hospitals in Vietnam. METHODS: We recruited patients with a pathogen (bacterial or fungal) cultured from a normally sterile sample. Samples were randomly assigned (1:1) to identification by MALDITOF-MS or conventional diagnostics. The primary outcome was the proportion on optimal antimicrobial therapy within 24 hours of positive culture, determined by a blinded independent review committee. Trial registered at ClinicalTrials.gov (NCT02306330). RESULTS: Among 1,005 randomised patients, pathogens were isolated from 628 (326 intervention, 302 control), with 377 excluded as likely contaminants or discharged/died before positive culture. Most isolates were cultured from blood (421/628, 67.0%). The proportion receiving optimal antimicrobial therapy within 24 hours (the primary outcome) or 48 hours of growth was not significantly different between MALDITOF-MS and control arms (135/326, 41.4% vs 120/302, 39.7%; Adjusted Odds ration (AOR) 1.17, p= 0.40 and 151/326, 46.3% vs 141/302, 46.7%; AOR 1.05 p=0.79 respectively). CONCLUSIONS: MALDITOF-MS, in the absence of an antimicrobial stewardship programme, did not improve the proportion on optimal antimicrobial therapy at 24 or 48 hours after first growth in a lower-middle income setting with high rates of antibiotic resistance. |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| Relation: |
https://doi.org/10.1016/j.jinf.2019.03.010 |
| DOI: |
10.1016/j.jinf.2019.03.010 |
| Availability: |
https://doi.org/10.1016/j.jinf.2019.03.010; https://ora.ox.ac.uk/objects/uuid:4f45f90b-78b2-423f-91f8-e47a64c63b70 |
| Rights: |
info:eu-repo/semantics/openAccess ; CC Attribution (CC BY) |
| Accession Number: |
edsbas.71660904 |
| Database: |
BASE |